An Afrocentric approach to peer mentoring in a decolonised curriculum for first-year Clinical Associate students at the University of Pretoria

Abstract

Introduction: First-year Clinical Associate (ClinA) students face more challenges than the average first-year student as they are educated in decentralised healthcare facilities predominantly in rural areas, where institutional support is not always available. Another concern is throughput rate – only 63% of BCMP students graduate in the minimum time of three years, while in comparison the throughput rate for medical students is 89 %. Their educational strategy is different from traditional strategies, incorporating authentic learning, self-directed learning, Whole Brain® learning and collaborative learning. The absence of existing literature on mentoring programmes tailored to students who navigate much of their academic experience without substantial access to university student support services underscored the necessity for a tailor-made approach. Peer mentoring was identified as an option, especially for ClinA students who do not have access to academic staff or campus-based support structures. This research study unfolded in multiple phases, with the overarching aim being the development, implementation, and evaluation of a peer mentoring programme expressly tailored for first-year undergraduate ClinA students. This aim was achieved through the formulation of a Short Learning Course (SLC) designed for the training of peer mentors within an Afrocentric, decolonised context.

Methods: A concurrent, embedded mixed methods study design was used for the multi-phased study. In Phase 1, the exploration of ClinA students' needs and challenges utilized a phenomenological research approach. Two qualitative methodologies, appreciative inquiry interviews and focus group discussions, were employed for this purpose. Phase 2 was done using a modified nominal group technique (mNGT) to establish group consensus on the learning outcomes and activities suitable for inclusion in the short learning course designed for peer mentor training. Following the mNGT, the curriculum was developed using Biggs’ constructive alignment as the design principle. Phase 3 of the study adopted an action research methodology. Action research is characterized by the inclusion of participants' feelings, perspectives, and patterns without external control or manipulation by the researcher. The procedural steps associated with action research were adhered to, including planning (identifying the need), acting (developing and implementing the SLC), observing, reflecting, and evaluating the SLC.

Results: The study revealed themes across various aspects of ClinA students’ environment. Challenges faced by ClinA students encompassed concerns about the teaching and learning strategies employed by programme facilitators, the decentralised nature of learning platforms, and a lack of institutional support at clinical learning centres. Benefits of peer mentoring were identified, including mentors serving as proxy representatives of institutional support, offering all-encompassing support, and functioning as advocates and role models. The perceived enablers of a peer mentoring programme's success included identifying individuals with suitable characteristics for peer mentoring, comprehensive training for peer mentors, and crucial support from the faculty. Conversely, perceived constraints involved the shortage of human and financial resources, time limitations, and concerns about the commitment levels of peer mentors. The efficacy of the modified Nominal Group Technique process was shown, emphasizing its ease of facilitation and cost-effectiveness. Learning outcomes and activities for a SLC for training of peer mentors, were carefully formulated, with a focus on academic support, guidance, and psychosocial assistance. The SLC curriculum emerged as a comprehensive framework aligning learning outcomes with objectives for peer mentors, emphasizing personal and academic development, effective communication, teamwork, and professional role modelling. The unintended alignment of identified outcomes with institutional graduate attributes reflects the programme's holistic nature, aiming to cultivate graduates with academic, clinical, and societal impact skills. The curriculum's commitment to decolonisation principles showcased practical applications, promoting cooperation, diverse representation, and shared knowledge benefits. Additionally, Whole Brain® learning was integrated, encouraging diverse thinking approaches among peer mentors. Participant perspectives, both quantitative and qualitative, provided valuable insights. While there was a shared understanding of programme goals, a consensus emerged that regular meetings were lacking. Qualitative themes encompassed the impact of strong relationships, challenges faced by peer mentor programme participants, and the advantages mentioned. Afrocentricity served as the philosophical paradigm for this study with incorporating the African canons, ujamaa (familyhood/community), utulivu (justice/peacefulness), kujitoa (dedication/commitment), uhaki (harmony/justice), and ukweli (truth) as standards of judgement.

Conclusion: This study embarked on a comprehensive journey to address the challenges of low throughput rates within the BCMP programme, specifically focusing on first-year ClinA students. Through an exploration of the unique needs and challenges of ClinA students in South Africa and an examination of the enablers and constraints of an effective peer mentoring programme, the study laid the groundwork for a transformative initiative. The next step was the development and implementation of a tailor-made online short learning course (SLC) for training peer mentors, rooted in decolonised curriculum principles and an Afrocentric lens as conceptual framework. The SLC achieved its objectives of cultivating personal and academic development, effective communication, teamwork, and professional role modelling. The structured outline of preparation, application, and consolidation phases contributed to the formation of well-rounded peer mentors capable of fostering a supportive environment for their mentees. Moreover, the study showcased the practical application of Le Grange and Makhele's 4Rs in evaluating educational programmes, emphasizing relational accountability, respectful representation, and reciprocal appropriation. The SLC not only contributed to individual growth but also instilled a culture of inclusivity and adaptability within the educational landscape. Overall, this research provides valuable insights and practical applications for enhancing peer mentoring programmes, specifically tailored for the unique context of ClinA students in the BCMP programme, setting a foundation for a more interconnected, diverse, and mutually beneficial educational environment. Embracing ubuntu and the African Canons in our ethical framework challenges existing perspectives, fostering an inclusive and compassionate society. This shift, coupled with an Afrocentric research approach, contributes to a more just and equitable future through heightened awareness of interconnectedness.